title: Perventricular closure of muscular ventricular septal defects in infants with echocardiographic guidance only.
abstract: OBJECTIVE
  To report our experience with perventricular closure of muscular (apical) ventricular septal defects (VSDs) in small infants, with echocardiographic guidance only, in a nonhybrid suite.
  
  
  METHODS
  Eight infants with nine large muscular (apical) VSDs underwent perventricular device closure in a nonhybrid operating room, with transesophageal and epicardial echocardiography guidance, at a mean age and weight of 3.07 (0.3-7.28) months and 3.7 (2.5-6.2) kg, respectively. Five patients had multiple VSDs. Four had associated cardiac defects.
  
  
  RESULTS
  Nine Amplatzer muscular VSD devices with a mean size of 10 (4-14) mm were deployed. Seven patients were discharged from the intensive care unit with a mean length of stay of 8.6 days. Four patients had minimal postprocedural residual shunt; no one had a residual shunt at six-month follow-up. Mid-term results are excellent.
  
  
  CONCLUSIONS
  Perventricular closure is feasible under echocardiographic guidance only in small patients, even without hybrid suite. This may be a good approach for very symptomatic low-weight infants with apical VSD and may also be useful, in any center, at any time, and in any operating room, to treat an associated apical VSD, even unexpected.
authors.affiliation: Department of Thoracic and Cardio-Vascular Surgery, Hôpital d'enfants de la Timone, Marseille, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Fouilloux
authors.forename: Béatrice
authors.initials: B
authors.lastname: Bonello
authors.forename: Célia
authors.initials: C
authors.lastname: Gran
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
authors.forename: Loïc
authors.initials: L
authors.lastname: Macé
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
keywords: echocardiography; infant; muscular ventricular septal defect; perventricular